Active NPI
Katelyn Wagoner
- Social Worker
- Spartanburg, SC
National Provider Identifier
1316612567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 17154
- Practice address
- 460 Langdon St
Spartanburg, SC 29302-1614 - Phone
- (719) 210-8194
- NPI assigned
- Aug 10, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 17154 | SC | Primary |
Addresses
Primary practice location
460 Langdon St
Spartanburg, SC 29302-1614
Mailing address
4042 Walloon LN Apt 311
Spartanburg, SC 29301-6626
Phone (719) 210-8194
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17154 | SC | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725926400000",
"number": "1316612567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4042 WALLOON LN APT 311",
"city": "SPARTANBURG",
"state": "SC",
"postal_code": "293016626",
"telephone_number": "719-210-8194"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "460 LANGDON ST",
"city": "SPARTANBURG",
"state": "SC",
"postal_code": "293021614",
"telephone_number": "719-210-8194"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGONER",
"first_name": "KATELYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-10",
"last_updated": "2024-09-10",
"certification_date": "2024-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "SC",
"license": "17154",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spartanburg, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.